tbuckley/cabot-search huggingface dataset:
Abstract 11476: The Clot Thickens: Massive Left Ventricular Thrombus After Sub-Acute Myocardial Infarction
Authors: Tiffany Ho, Belal Noureddine, Mohammed Haji, Sanchita S Parulkar, Joseph Wyllie, ANDREW LEVINSON
Journal: Circulation (2022)

Introduction: Left ventricular thrombus (LVT) following myocardial infarction (MI) can affect up to 19.2% of patients with anterior wall MI. The mechanism is thought to be due to stasis from LV regional wall akinesia, endothelial injury from prolonged ischemia, and hypercoagulability from acute coronary syndrome. In patients with LVT after MI, anticoagulation choice and duration is still a matter of debate. Case Report: A 51-year-old woman with diabetes and prior anterior wall MI with LVT presented with non-healing diabetic leg wounds. One year ago at the time of the MI, transthoracic echocardiogram (TTE) showed a 4.0 x 1.3 cm mural thrombus. She was discharged on prasugrel and apixaban. Apixaban was discontinued after five months, with follow-up TTE showing resolution of LVT, with 30% LV ejection fraction and evidence of LV remodeling. This hospitalization, while awaiting discharge, the patient developed sudden undifferentiated shock requiring norepinephrine and dobutamine. Repeat TTE revealed a 6.0 x 5.5 cm apical LVT filling more than 50% of the LV cavity, with unchanged LV ejection fraction. Heparin drip was started. Prior to evaluation by cardiothoracic surgery, patient became acutely unresponsive, had a cardiac arrest, and expired. Cause of death suspected to be due to cardioembolic events, worsened with mixed shock and low-output heart failure from LVT. Discussion: Management of LVT after MI remains unclear. Current guidelines indicate treatment with vitamin K antagonist (VKA) for at least 3 - 6 months, and consideration of prophylactic anticoagulation with VKA for patients with apical dyskinesis after MI. Retrospectively, this patient may have benefitted from a prolonged course of anticoagulation given the extent of LV remodeling five months after initial event despite resolution of LVT. Anticoagulation must be evaluated on a case-by-case basis weighing propensity of thrombotic events with risk of bleeding.
Abstract 12648: Comparison of Transthyretin Amyloid Cardiomyopathy Patients Taking Tafamidis and Those Not Taking Tafamidis Using Two-Dimensional Speckle Tracking Echocardiography
Authors: Fumi Oike, Hiroki Usuku, Kouichi Egashira, Takashi Komorita, Koichiro Fujisue, Daisuke Sueta, Seiji Takashio, Eiichiro Yamamoto, Kenichi Tsujita
Journal: Circulation (2022)

Objectives: Tafamidis is an effective treatment for transthyretin amyloid cardiomyopathy (ATTR-CM), this study investigated the effect of tafamidis on left heart function in ATTR-CM patients by using two-dimensional speckle tracking echocardiography. Methods and Results: We evaluated 222 consecutive patients with ATTR-CM who were diagnosed at our department between January 2002 and February 2022 retrospectively. Eighty patients taking tafamidis had a history of echocardiography before and 12 months after treatment, and thirty-four untreated patients had a history of echocardiography after diagnosis and 12 months later. Serum high-sensitivity cardiac troponin T (hs-cTnT) significantly decreased in the treatment group (hs-cTnT :0.067±0.037 vs. 0.056±0.031, p&lt;0.01) but didn’t change significantly in the untreated group (hs-cTnT :0.085±0.110 vs. 0.084±0.070, p=0.98). Plasma B-type natriuretic peptide did not change significantly in each group. Creatinine increased significantly in the treatment group (creatinine:1.12±0.31 vs. 1.19±0.50, p=0.03) and did not change in the untreated group (creatinine:1.40±0.91 vs. 1.48±0.90, p=0.17). Left ventricular global longitudinal strain (LVGLS) and left atrial strain rate during atrial contraction (LASRa) didn’t change significantly in the treatment group (LVGLS: -8.4±2.9 vs. -8.3±2.9, p=0.30 LASRa: -0.24±0.21 vs. -0.23±0.18, p=0.49) but increased significantly in the untreated group (LVGLS: -10.9±3.3 vs. -7.8±5.2, p&lt;0.01, LASRa: -0.44±0.39 vs. -0.29±0.24, p=0.01). Conclusion: Tafamidis may be effective in maintaining left heart function in ATTR-CM patients.
Abstract 12574: Highest Post-PCI Ischemic Event Occurrences in African American Men During COVID-19 Outbreak Compared to Before COVID-19: A Community Hospital Experience
Authors: Sanchit Duhan, Juzer Ali Asgar, Parshotam Kundan, Naval Walia, Kevin Bliden, Charles Cummings, Mohammed Abuzara, Arvind Singh, Udaya Tantry, Paul Gurbel
Journal: Circulation (2022)

Introduction: African Americans (AAs) have a higher risk for post-PCI ischemic events and worse COVID-19-related events than non-AAs. Race and gender-related post-PCI events before and during the COVID-19 pandemic in a community hospital setup are unknown. Methods: Demographics and one-year post-PCI ischemic event occurrences were compared between AAs and non-AAs undergoing PCI immediately before (2017-2019) and during COVID-19 (2020-2022) in an urban community hospital. Results: In total, 291 and 292 non-AAs and 221 and 219 AAs who underwent PCI before and during the COVID-19 pandemic respectively, were included in the analysis. AAs were younger and had a higher prevalence of diabetes and ACS (p&lt;0.01 for all). Among non-AAs, there were no differences in major demographics except a higher % of pts with prior PCI (p=0.02) before vs. during COVID-19. Platelet counts were higher in both groups during COVID-19 (p≤0.008) (Table). Among AAs, % of pts with ACS was higher during COVID-19 (p=0.003) which was mainly driven by a higher % of NSTE-ACS (p&lt;0.001). In total, one-year recurrent ischemic events were higher during the COVID-19 pandemic compared to before (112 vs. 198, p&lt;0.001). Among non-AAs, although the total number of events was higher during COVID-19 (p&lt;0.001), % of pts with events were similar and all-cause death and MI were higher during the COVID-19 (p≤0.008). Among AAs, both total events and % of pts with events were higher during COVID-19 (p≥0.02). Except for all-cause death, other ischemic events were higher in AAs during COVID-19 (p≤0.02) which occurred in men (p=0.0001) but not in women (p=ns). TIMI bleeding events were numerically lower during COVID-19 Conclusions: In our community hospital, AAs have a higher risk for post-PCI ischemic events which mainly occurred in men during COVID-19, whereas non-AAs have a similar risk before and during COVID-19. This data suggest that AA men with COVID-19 undergoing PCI should be treated with aggressive antiplatelet therapy.
Abstract 11787: Impact of Estimated Plasma Volume Status on Clinical Outcomes in Lower Extremity Artery Disease Patients Who Underwent Endovascular Therapy
Authors: Tasuku Kurokawa, yoichiro Otaki, Hiroki Takahashi, Tetsu Watanabe, Taku Shikama, Harutoshi Tamura, Shigehiko Kato, Satoshi Nishiyama, Takanori Arimoto, Masafumi Watanabe
Journal: Circulation (2022)

Introduction: Lower extremity artery disease (LEAD) is an arterial occlusive disease associated with high morbidity and mortality. Estimated plasma volume status (ePVS), a marker of plasma volume expansion and contraction, is gaining attention in the field of cardiovascular disease. However, it remains undetermined the impact of ePVS on clinical outcome in patients with LEAD. Methods: We calculated two ePVS using Kaplan-Hakim and Duarte formula in 288 LEAD patients who underwent first endovascular therapy and retrospectively followed during a median follow-up period of 617 days. The primary and secondary endpoints were composite events including all-cause death and major adverse limb events (Death/MALE) and major adverse cardiovascular events (MACE), respectively. Results: ePVS significantly increased with advancing Fontaine class. All patients were divided into two groups based on the median ePVS value. Kaplan-Meier analysis demonstrated high ePVS group had higher incidence of composite events and MACE compared to low ePVS group. A multivariate Cox proportional hazard analysis revealed that ePVS was an independent predictor of Death/MALE and MACE after adjustment for confounding risk factors. Prognostic ability for Death/MALE was significantly improved by addition of ePVS to the basic predictors. These results are consistent with each formula. Conclusions: ePVS was associated with severity of LEAD and clinical outcome, suggesting ePVS could be an additional risk factor for Death/MALE and MACE in LEAD patients who underwent endovascular therapy.
Abstract 11318: A Rare Case of Stretch Syncope of Adolescence Masquerading as Carotid Artery Dissection and Carotid Sinus Syndrome
Authors: Rahul Mital, Kelly Henry
Journal: Circulation (2022)

Introduction: Syncope describes a brief, sudden loss of consciousness and tone, with spontaneous return to baseline. Although episodes arise from a transient interruption of cerebral blood flow, work-up identifying an underlying is critical, as it can determine the proper treatment for cessation of these episodes. In this case, we describe a patient who was later diagnosed with stretch syncope of adolescence (SSA), a rarely reported cause of syncope. Case Presentation A 16-year-old male presented to the E.R. after experiencing a syncopal event immediately after looking up. He endorsed a similar episode one week earlier, after standing and looking up. The patient also revealed that he commonly would crack his neck and would often sleep with his head extended over the arm of his couch. In the E.R., the patient was hypotensive to 107/62 mmHg, but physical exam and lab work-up did not reveal any significant pathology. EKG and a CT head without IV Contrast showed no acute intracranial abnormality. Soon after admission, he became bradycardic, hypotensive, and lightheaded. Due to concern for carotid artery dissection, bilateral carotid duplex scan and CT of the head and neck were completed, and given the reproducibility of the patient’s symptoms with neck dorsiflexion, an MRI to evaluate for carotid sinus syndrome was completed. All imaging, however, returned unremarkable. Given the patient’s age, symptom onset with movement, and exclusion of other etiologies, a diagnosis of SSA was made. The patient was discharged with strict instructions to avoid stretching, especially when standing. Discussion SSA is characterized by episodic loss of consciousness triggered by a combination of stretching and neck hyperextension. It is a rarely reported phenomenon, with only 14 case reports published on SSA as of 2014, and is often confused with more common syndromes, most commonly epileptic seizures. Our case is especially unique because the patient’s presentation was initially most consistent with carotid artery dissection and coronary sinus syndrome, a previously unreported presentation. By continuing to recognize and report cases such as ours, patients with SSA may receive more prompt diagnosis, avoid extraneous work-up, and ultimately, prevent future syncopal events.
Abstract 11931: Plasma Volume Status at Cardiovascular Intensive Care Unit Discharge and Hospital Discharge is Associated With Overall Survival in Patients With Acute Decompensated Heart Failure
Authors: Yu Hoshika, Yoshiaki Kubota, Takuya Nishino, Jun Nakata, Hideki Miyachi, Yu-ki Iwasaki, Wataru Shimizu, Takeshi Yamamoto
Journal: Circulation (2022)

Background: Plasma volume status (PVS), a measure of plasma volume, has been evaluated as a prognostic marker for chronic heart failure. However, the significance of PVS in patients with acute decompensated heart failure (ADHF) admitted to the cardiovascular intensive care unit (CICU) remains unclear. Therefore, we examined the relationship between PVS and the long-term mortality. Method: Of 389 consecutive patients admitted to our CICU for ADHF from January 2018 to December 2020, a total of 206 patients (74.9 ± 12.9 years, 64.6% male) were enrolled, excluding those who received red blood cell transfusion, underwent dialysis, were discharged directly from the CICU, or died in the hospital. We measured PVS during the CICU stay and at discharge using the Kaplan-Hakim formula, and examined the association with all-cause mortality during the observation period (1037 days). Result: The group with decreasing PVS at 3 points, at admission to the CICU, at transfer to the GW, and at discharge, had a 3-year mortality rate of 0%. Cut-off values to predict long-term mortality were 10% and 9% for PVS at transfer to the GW and discharge according to ROC curve, respectively. All patients were divided into 2 groups by cut-off values, respectively, and the high PVS group had a significantly higher mortality rate (Figure 1, 2). In COX regression analysis, significant poor prognostic factors were PVS at transfer to the GW (HR=1.086 [1.04-1.13], P&lt;0.001), PVS at discharge (HR=1.073 [1.03-1.12], P&lt;0.001), and age (HR=1.052 [1.00-1.10], P=0.04). In multivariate analysis, PVS at discharge (HR=1.058 [1.00-1.12], P=0.048) was independent poor prognostic factor. Conclusions: In patients with ADHF who were admitted to the CICU, PVS at discharge may be useful in predicting prognosis. It is necessary to consider whether the treatment of heart failure that lowers PVS contributes to improved prognosis.
Abstract 12354: Novel Coronavirus Disease 2019 Infection in a Cohort of Patients With Phenotypic Hypertrophic Cardiomyopathy: An Extended Report
Authors: Leyla Gasimli-Gamache, Marjolein Le, Felicia Cabrera, Jamshid Shirani
Journal: Circulation (2022)

Background: Patients with preexisting heart disease suffer more severe outcomes after COVID-19. Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac conditions. We previously reported incidence and outcomes of COVID-19 in HCM in early days of the pandemic. We report results from an expanded and extended HCM cohort. Methods: 343 patients with HCM [age 59±17 years, 55% men, 19% NYHA class &gt;1, 63% obstructive, 14% septal reduction therapy, 24% positive family history, 42% selectively genotyped (43% positive for pathogenic mutations), 22% implantable cardioverter-defibrillator (ICD) implants, 27% paroxysmal or permanent atrial fibrillation (AF), 4% AF ablation] were evaluated for COVID-19 from December 2019 to May 2022. Results. Overall, 54 (16%) patients were diagnosed with COVID-19 [56% men, age 55±17 years, 60% obstructive HCM, 5.5% dilated phase HCM, 28% positive family history, 15% genotype positive, 28% with ICD, 17% NYHA class &gt;1, 31% AF]. There were 289 patients without COVID-19 [55% men, age 58±17 years, 63% obstructive HCM, 3% dilated phase HCM, 23% positive family history, 17% genotype positive, 21% with ICD, 19% NYHA class &gt;1, 27% AF]. Patients with COVID-19 were slightly younger (55±17 vs 58±17 years, p 0.046) and more often had dilated phase HCM (5.5% vs 3%) and more often had ICD (28% vs 21%). Eleven (20%) patients with COVID-19 were hospitalized and 1 (2%) died of the disease. Compared to those with mild disease, hospitalized patients with COVID-19 were more often men (82% vs 49%, p 0.04), older (age 59±15 vs. 54±18 years), with obstructive phenotype (73% vs 56%) and with NYHA class &gt;1 symptoms (27% vs 12%). In the studied patient cohort 70% had at least one dose of COVID-19 vaccine. Prior to the infection 63% of patients had no vaccination against SARS-CoV2. Among hospitalized patients 9 (82%) had no vaccination and 2 (18%) were vaccinated and had mild disease. Conclusions. Although Covid-19 infection rate (16%) in studied cohort was slightly lower than in general US population (~25%), hospitalization rate was higher (20% vs 9%) with similar death rates (1-2%). Older man with symptomatic obstructive HCM phenotype noted to have higher risk for hospitalization. Patients with vaccination against SARS-Cov2 tended to require less hospitalization.
Abstract 12343: Competing Roles of Angiostatin on SARS-CoV-2 Cellular Infection: Effects of Acidosis
Authors: Aleksandra Franczak, Michael Joyce, Lorne Tyrrell, Paul Jurasz
Journal: Circulation (2022)

Introduction: Angiostatin - plasmin(ogen) break-down product - is generated by platelets in an urokinase(uPA)-dependent manner. Angiostatin is anti-inflammatory during normoxia, and pro-apoptotic during hypoxia/acidosis. In SARS-CoV-infected mice, the uPA-plasminogen pathway was transcriptionally enriched regulating sublethal vs. lethal infection. Similarly, uPA was transcriptionally upregulated in SARS-CoV-2; however, role of angiostatin has not been investigated. Angiostatin level progressively increases in the blood of severe COVID-19 patients and this increases risk of lethal infection. We aimed to assess role of angiostatin in COVID-19. Methods: VeroE6 cells were infected with wild-type SARS-CoV-2 and treated with angiostatin (140 μg/ml) at pH 7.5 or 6.9. Cell death was quantified by the percentage of detached cells. Immunofluorescent staining against spike protein was used to confirm cellular infection. Additionally, HEK293-ACE2 cells were infected with replication-incompetent SARS-CoV-2 Reporter Virus Particles (RVP; GFP-expressing; Wuhan-Hu-1 D614G) with/without angiostatin and analyzed by flow cytometry. Co-immunoprecipitation of angiostatin and spike protein (Alpha variant) was carried out, followed by SDS-PAGE. Results: At pH 7.5 angiostatin significantly decreased the percentage of detached (24±7 vs 58±6%, p=0.002) VeroE6 following infection, and did not have a significant effect on uninfected cells. Conversely, at pH 6.9 angiostatin alone increased the percentage of detached cells (25% detachment, p=0.014), and failed to reduce the death of infected cells (detachment:53.5±4 vs 50±5%). Angiostatin lowered the percentage of spike protein-positive VeroE6 (59±3 vs 89±3%, p&lt;0.001) and GFP-expressing HEK293-ACE2 (7±0.5 vs 29±3, p=0.001) at both pH 7.4 and 6.9. Spike protein and angiostatin were co-immunoprecipitated. Conclusions: Angiostatin likely has a complex role in COVID-19 pathophysiology. High angiostatin concentrations such as those observed in COVID-19 promote cell death in acidotic microenvironments. Conversely, at physiological pH, angiostatin may have protective effects. Irrespective of pH, angiostatin reduced SARS-CoV-2 cellular entry, possibly by interacting with spike protein.
Abstract 11914: VSIG4+ Resident Tissue Macrophages Govern Cardiac Remodeling and Function After Acute Myocardial Infarction in Mice
Authors: Paul Alayrac, Alexandra Achab Ali, Yanyi Sun, Vincent Duval, Mathilde Lemitre, Jose Vilar, Angelique Levoye, Stephane Camus, Clement Cochain, Jean-Sebastien Silvestre
Journal: Circulation (2022)

Introduction. Resident tissue macrophages (RTM) are essential cellular hubs regulating tissue homeostasis beyond their classical immune surveillance functions. Of note, after acute myocardial infarction (AMI), cardiac RTM have been shown to inhibit fibrosis, promote angiogenesis, and foster the anti-inflammatory response to injury by interacting with other immune cell types, such as monocytes and T lymphocytes, to drive them towards pro-healing phenotypes. Hypothesis. Using Single Cell RNA Sequencing, we identified a new subpopulation of cardiac RTM characterized by the expression of VSIG4 (B7 family-related protein V-set and Ig domain-containing 4). In this work, we hypothesized that VSIG4+ RTM display protective function in the infarcted heart. Method and results. Visg4 deficient mice showed adverse cardiac remodeling and worsened cardiac function at day 14 and 28 after the onset of ischemia when compared to their wild-type littermates. Echocardiography-based transthoracic injection of FACS-sorted cardiac VISG4+ macrophages into infarcted hearts 2 weeks post-AMI, improved cardiac function in both WT and Vsig4 -/- mice, underlying the protective role of VSIG4+ RTM in this pathological setting. Conversely, injection of Vsig4 -/- macrophages impaired cardiac function in WT and Vsig4 -/- animals. VSIG4 deficiency is associated with a higher number of neutrophils, inflammatory monocytes and macrophages but also with a reduction in the amount of CCR5+ regulatory T lymphocytes in the cardiac tissue without any changes in blood, bone marrow and spleen. In cultured peritoneal macrophages, a prototypical example of RTM, IL4 and IL13 stimulation improved VSIG4 mRNA and protein levels through IL4 receptor alpha and IL13 receptor alpha1 activation. IL4 and IL13 treatment also increased secretion of CCL3 and CCL4, two chemokine ligands of CCR5, these effects were blunted in VSIG4 deficient macrophages. Conclusion. VSIG4+ RTM are key regulators of cardiac remodeling after AMI likely through their ability to hamper inflammation and recruit protective regulatory T cells in infarcted heart.
Abstract 11209: The Distance From the Right Coronary Artery to the Cavotricuspid Isthmus is a Predictor of First-Pass Conductional Block of Cavotricuspid Isthmus by Cryoablation
Authors: Minoru Nodera, Takeshi Nehashi, Shinya Yamada, Takashi Kaneshiro, Yasuchika Takeishi
Journal: Circulation (2022)

Background : Several studies have reported that the blood flow in the right coronary artery (RCA), located beneath the anterior cavotricuspid isthmus (CTI), has cooling effect which might prevent CTI block from radiofrequency ablation and make this ablation procedure difficult. However, the details of this effect by RCA blood flow remain unclear in cryoablation of CTI. Methods: This study included 63 consecutive patients (46 men; 66±11 years) who underwent CTI cryoablation for common AFL. A computed tomography (CT) scan with contrast injection was performed before ablation in all patients. Patients were divided into 2 groups: one pass group who achieved first-pass conductional block of the CTI (n=47) and non-one pass group who did not (n=16). CTI ablation was performed with 2.5-min freezing cycles and 8-mm tip cryocatheter. We analyzed anatomical features of the CTI, the presence of Eustachian valves on CT, and the temperature changes at the catheter tip during first pass in CTI cryoablation. Results: The distance from the RCA to the CTI in the one pass group was significantly longer than that in the non-one pass group (2.9±0.7 vs. 2.2±0.6 mm, P &lt;0.001). On the other hand, there was no significant difference in the variants of CTI anatomy or the CTI length or the presence of a Eustachian valve between the two groups. The time to reach the nadir freezing temperature in the anterior CTI, where the RCA was located beneath it, was significantly shorter in the one pass group than in the non-one pass group (31.3±6.5 vs. 34.7±6.1 sec, P =0.034). The time to reach the nadir freezing temperature in the anterior CTI correlated inversely with the distance from the RCA to the CTI (R=-0.404, P =0.001). Using multivariate analysis, the distance from the RCA to the CTI was an independent predictor of achievement of first-pass conductional block of the CTI (odds ratio 8.776, 95% confidence interval 2.358-32.662, P =0.001). The distance from the RCA to the CTI &gt;2.2 mm had 83% sensitivity and 63% specificity to predict one pass conduction block (area under the curve, 0.813). Conclusions: The distance from the RCA to the CTI is a predictor of first-pass conductional block of CTI by cryoablation. The warming effect of the RCA blood flow might prevent CTI block during cryoablation.